The Millennium Global Village-Network:
Helping to Achieve the MDGs by
Improving Quality, Access and Efficiency
Andrew S. Kantera,b,c, Patricia Mechaela, Matt Berga
Columbia International eHealth Laboratory (CIEL)
a Millennium
Villages Project, Earth Institute, Columbia University, New York, USA
b Department of Biomedical Informatics, Columbia University, New York, NY, USA
c Department of Epidemiology, Mailman School of Public Health, Columbia University,
New York, NY, USA
1
Agenda
Millennium Villages Project Overview
The Problem
MGV-Net Solution: OpenMRS/ChildCount+
Terminology/Enterprise Architecture
OASIS II Evaluation and Malaria in Uganda
2
Millennium Villages Project
Partnership between the Earth Institute
Columbia University, UNDP, Millennium Promise
and national governments.
Primarily operates in 10 countries in 14
agro-ecological zones in Sub-Saharan Africa
Integrated development at $120 pc/y
3
Millennium Villages
Koraro, Ethiopia
Timbuktu, Mali
Bonsaaso, Ghana
Ikaram, Nigeria
Dertu, Kenya
Pampaida, Nigeria
Sauri, Kenya
Mayange, Rwanda
Gumalira, Malawi
Potou, Senegal
Mwandama, Malawi
Mbola, Tanzania
Tiby, Mali
Ruhiira, Uganda
4
Role of Health Information
Three of eight MDGs are
health-related
MVP establishes one clinic per 5000 people
1 CHW for 100 HH
Improve care
Assess impact and effectiveness of program
5
6
Comparable and Timely Data
Nov. – Jan Ave.
Feb. – April
Ave.
% Change
% of patients
treated
<5
50.0%
24.4%
-51.3%
>= 5
35.4%
12.3%
-65.4%
% suspected
<5
73.7%
73.5%
0.4%
>= 5
58.3%
53.3%
-8.5%
<5
67.2%
32.3%
-51.0%
>= 5
60.2%
22.6%
-62.4%
377
165
-56.3%
% suspected,
treated
Coartem
80.0%
70.0%
60.0%
50.0%
Uganda
40.0%
Rwanda
30.0%
20.0%
10.0%
7
0.0%
11
12
1
2
3
FIGURE 1. eHealth M&E Logical Framework
INPUTS
OUTPUTS
OUTCOMES
Basic Voice and Text
Communication
Computers/Servers/
Mobile Phones
Electronic Medical
Records
Telecommunications
Infrastructure
Raise knowledge and
awareness about
diseases
Community
Mobilization, Wellbeing,
and Empowerment
Reduce Error Rates
from Data Entry
Community Health
Care Worker Training
Emergency Medical
Services protocol
Non-emergent
referral system
Improve access and
quality of health care
Behavior Change
Reduce administrative
and point-of-care costs
Supply Chain
Management
Monitor and target
specific MDG indicators
Improve point-of care
decision making and
service delivery
Telemedicine system
mHealth Applications
and mLearning
Leverage Achievement
of MDGs
Goal 4: Reduce Child
Mortality
Goal 5: Improve Maternal
Health
Goal 6: Combat
HIV/AIDS, Malaria, other
diseases
Data warehouse
Disease Surveillance
and Early Warning
Capacity Building
IMPACT
Improve treatment
compliance
Improve disease
prevention
8
Improve coordination
and administration of
health service delivery
Reduce time to access
care
Improve Intra-facility
Communication
Reduce Isolation/
Improve Psychosocial
Outcomes
Improve Monitoring
and Evaluation
Millennium Global Village Network
Courtesy of Andrew Kanter. Used with permission.
9
Vision: MGV-Net Information System
Bottom-up
Patient-centered
Locally-owned/maintained
Integrated/interoperable
Provide local value
Global reach
Sustainable
10
ChildCount+
OpenMRS
MGV-Net
11
CHW Decision Support and Info System
12
Looking up Patients…
Courtesy of Andrew Kanter. Used with permission.
13
Prior Encounters…
Courtesy of Andrew Kanter. Used with permission.
14
View Prior Encounters
Courtesy of Andrew Kanter. Used with permission.
15
French
Same Data in
multiple languages
English
Courtesy of Andrew Kanter. Used with permission.
16
Courtesy of Andrew Kanter. Used with permission.
17
Terminology Service Bureau- 50,000 concepts
Courtesy of Andrew Kanter. Used with permission.
18
Nigeria
Philippines
Peru
Malawi Nepal
Kenya
India
Uganda
Senegal
Chile
Rwanda
Indonesia
Tanzania
Afghanistan Nicaragua
Ghana
Mali
...
Common
Data
Dictionary
19
OASIS II Study-Evaluating Impact
The proposed research systematically evaluates the impact
of all MGV-Net components (e.g. ChildCount+; OpenMRS)
on various aspects of the healthcare delivery system
including:
service coverage;
quality of services;
early detection, referral, and treatment of danger signs
morbidity and mortality
management of resources (human, financial, etc)
20
OASIS II Study Design
Mixed methods
Retrospective Case-Control- exposure to on-time
CHW visits
Repeated Measures with & without MGV-Net
Action Research Component
Repeated Measures of Paper vs. SMS
21
Malaria in Uganda- Action Research
Key measure of
success
Preintervention
Patients treated who were 90%
not tested or tested
negative
Patients treated who
tested negative
48%
Patients treated who
tested positive
10%
22
Malaria in Uganda- Action Research
Key measure of
success
Preintervention
Post-intervention
Patients treated who were 90%
not tested or tested
negative
32%
Patients treated who
tested negative
48%
12% in Q1
18% in Q4
Patients treated who
tested positive
10%
30% in Q1
58% in Q4
23
Challenges and Lessons Learned
Human capacity
Clinician engagement
Reliable electricity,
computers, connectivity
Need interoperability
Need maturity model
Gov’t policies
24
Shared Terminology and Resources
www.maternalconceptlab.com
www.openmrs.org
www.childcount.org
25
MIT OpenCourseWare
http://ocw.mit.edu
HST.S14 Health Information Systems to Improve Quality of Care in Resource-Poor Settings
Spring 2012
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